Healthcare Provider Details

I. General information

NPI: 1275565269
Provider Name (Legal Business Name): DR JOEL N. ZABA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 INDEPENDENCE BLVD PEMBROKE ONE #105
VIRGINIA BEACH VA
23462-2986
US

IV. Provider business mailing address

1232 W LITTLE CREEK RD # 200
NORFOLK VA
23505-1952
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-9575
  • Fax: 757-497-1292
Mailing address:
  • Phone: 757-489-9656
  • Fax: 757-423-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0618000449
License Number StateVA

VIII. Authorized Official

Name: DR. JOEL N ZABA
Title or Position: OWNER
Credential: O.D.
Phone: 757-497-9575